Antibiotic Stewardship in European Nursing Homes: Experiences From the Netherlands, Norway, Poland, and Sweden

Buul, Laura W van; Monnier, Annelie A; Sundvall, Pär‐Daniel; Ulleryd, Peter; Godycki-Cwirko, Maciek; Kowalczyk, Anna; Lindbæk, Morten; Hertogh, Cees M.P.M.

doi:10.1016/j.jamda.2019.10.005

Cited by 17 publications

(16 citation statements)

References 25 publications

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“…In Switzerland, ASP activities including local multidisciplinary networks (micro-level strategy) and guidelines publication (macro-level strategy) led to a 22% reduction in antibacterial use over a 6-year period (Table 2 ) [ 30 ]. A recent paper described the ASP implementation experience in four European countries (Norway, The Netherlands, Poland and Sweden) where various regional or national ASP initiatives have recently been introduced [ 51 ]. The ASP components included national surveillance systems, NH-specific prescribing guidelines and national networks of healthcare institutions.…”

Section: Methodsmentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

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Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.

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Section: Methodsmentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

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“…Over the past few years there has been increased scientific and political attention for antibiotic stewardship in the long-term care setting in the Netherlands [24]. This has triggered a wide range of activities by several parties, focused on improving infection prevention and appropriate antibiotic use in NHs.…”

Section: External Antibiotic Stewardship Effortsmentioning

confidence: 99%

Antibiotic prescribing and non-prescribing in nursing home residents with signs and symptoms ascribed to urinary tract infection (ANNA): study protocol for a cluster randomized controlled trial

et al. 2020

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Background Antibiotic overprescribing for suspected urinary tract infection (UTI) in nursing homes (NHs) is common. Typical clinical scenarios in which antibiotics are inappropriately prescribed include response to nonspecific signs and symptoms and/or a positive urine test in the absence of symptoms referable to the urinary tract. These and other scenarios for inappropriate antibiotic prescribing were addressed in a recent international Delphi study which resulted in the development of a decision tool for the empiric treatment of UTI in frail older adults. The aim of the current study is to implement this decision tool, by integrating it into the electronic health record (EHR) and providing education on its content and use, and to evaluate its effect on appropriate antibiotic prescribing. An additional aim is to evaluate the quality of the intervention and the implementation process. Methods A cluster Randomized Controlled Trial (cRCT) is conducted in sixteen NHs and aims to include 897 residents diagnosed with suspected UTI. NHs in the intervention group use the EHR-integrated decision tool, and receive education for physicians and nursing staff; in the control group care as usual is provided. Data is collected through case report forms within the EHR at the day of diagnosis and at 3, 7, and 21 days thereafter. The primary outcome is appropriate antibiotic prescribing for suspected UTI at the day of diagnosis. Secondary outcomes include the course of symptoms, alternative diagnoses, treatment changes, complications, hospitalization, and mortality. Data on total antibiotic prescribing are additionally collected in the participating NHs 12 months before and during the study. Finally, the process evaluation combines cRCT data with questionnaires and qualitative interviews with NH professionals. Discussion This is the first cRCT to evaluate the recently developed, international decision tool for empiric treatment of suspected UTI in NH residents. Study findings will elucidate the effect of the intervention on appropriate antibiotic prescribing for suspected UTI, and provide insight into the applicability of the decision tool in NHs in general and in specific subgroups of NH residents. With this study we aim to contribute to antibiotic stewardship efforts in long-term care. Trial registration The ANNA study was registered at the Netherlands Trial Register on 26 February 2019, with identification number NTR NL7555.

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“…There was no substantial improvement in the presence of these antibiotic stewardship elements in the 2016–17 HALT survey [ 62 ]. While many countries release national strategies to combat antimicrobial resistance that address human antibiotic use, these tend to focus on strategies and targets for community and hospital antibiotic use [ 122 – 124 ]. Our results highlight the need for specific strategies for LTCFs, particularly since LTCFs serve a unique population with complex care needs distinct from the general population.…”

Section: Discussionmentioning

confidence: 99%

Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019: Systematic review and meta-analysis

et al. 2021

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Background Antibiotic misuse is a key contributor to antimicrobial resistance and a concern in long-term aged care facilities (LTCFs). Our objectives were to: i) summarise key indicators of systemic antibiotic use and appropriateness of use, and ii) examine temporal and regional variations in antibiotic use, in LTCFs (PROSPERO registration CRD42018107125). Methods & findings Medline and EMBASE were searched for studies published between 1990–2021 reporting antibiotic use rates in LTCFs. Random effects meta-analysis provided pooled estimates of antibiotic use rates (percentage of residents on an antibiotic on a single day [point prevalence] and over 12 months [period prevalence]; percentage of appropriate prescriptions). Meta-regression examined associations between antibiotic use, year of measurement and region. A total of 90 articles representing 78 studies from 39 countries with data between 1985–2019 were included. Pooled estimates of point prevalence and 12-month period prevalence were 5.2% (95% CI: 3.3–7.9; n = 523,171) and 62.0% (95% CI: 54.0–69.3; n = 946,127), respectively. Point prevalence varied significantly between regions (Q = 224.1, df = 7, p<0.001), and ranged from 2.4% (95% CI: 1.9–2.7) in Eastern Europe to 9.0% in the British Isles (95% CI: 7.6–10.5) and Northern Europe (95% CI: 7.7–10.5). Twelve-month period prevalence varied significantly between regions (Q = 15.1, df = 3, p = 0.002) and ranged from 53.9% (95% CI: 48.3–59.4) in the British Isles to 68.3% (95% CI: 63.6–72.7) in Australia. Meta-regression found no association between year of measurement and antibiotic use prevalence. The pooled estimate of the percentage of appropriate antibiotic prescriptions was 28.5% (95% CI: 10.3–58.0; n = 17,245) as assessed by the McGeer criteria. Year of measurement was associated with decreasing appropriateness of antibiotic use over time (OR:0.78, 95% CI: 0.67–0.91). The most frequently used antibiotic classes were penicillins (n = 44 studies), cephalosporins (n = 36), sulphonamides/trimethoprim (n = 31), and quinolones (n = 28). Conclusions Coordinated efforts focusing on LTCFs are required to address antibiotic misuse in LTCFs. Our analysis provides overall baseline and regional estimates for future monitoring of antibiotic use in LTCFs.

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Antibiotic Stewardship in European Nursing Homes: Experiences From the Netherlands, Norway, Poland, and Sweden

Cited by 17 publications

References 25 publications

Interventions to optimize medication use in nursing homes: a narrative review

Interventions to optimize medication use in nursing homes: a narrative review

Antibiotic prescribing and non-prescribing in nursing home residents with signs and symptoms ascribed to urinary tract infection (ANNA): study protocol for a cluster randomized controlled trial

Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019: Systematic review and meta-analysis

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